Hair Loss

1. We do not grow new hair after we are born

2. Normal hair loss from adult scalp is 50-100 hair per day
3. Tends to affect people from 2nd decade onwards
4. In women, hair loss is more pronounced after menopause
5. Men more susceptible and usually experience more severe hair loss
6. Hair growth rate is different from one person to another
7. 2 types of hair loss; anagen effluvium and telogen effluvium
8. Hair loss can be classified as Male Pattern baldness, female pattern baldness, Alopecia
areata (patchy), alopecia totalis (loss of hair on whole scalp), Alopecia universalis (loss of hair
on scalp and parts of body). The three alopecia’s are auto-immune disorders
9. Pharmacy can only manage pattern baldness
10. Pharmacy can only treat vertex pattern baldness not anterior pattern baldness
11. With otc products, only provide for androgenic alopecia (check if patient has family history
before supplying otc product)

Triggers for hair loss

Major physical-emotional stress:

1. Surgical trauma
2. Chronic systemic illnesses (diabetes)
3. High fever
4. Hemorrhage
5. The above cause telogen effluvium 2-3 months after the insult
6. Telogen effluvium can also be experienced 2-4 months after childbirth (sudden drop in
estrogen levels, but temporary)

Medical conditions:

1. Hypo or Hyper- Thyroidism, kidney failure, Inflammatory bowel diseases which cause
deficiency in nutrients, lupus disease, HIV.

Diet:

1. Zinc, iron deficiency

2. Vitamin d deficiency
3. Malabsorption syndromes and pancreatic disease can cause telogen hair shedding (More
hair in resting than growing phase).

Drugs:

1. OCP
2. Androgens
3. Retinoids
4. Lithium
5. Beta blockers
 6. Ace inhibitors
7. Anti-coagulants
8. Above all cause telogen effluvium (mode of action targeting differentiating cells)
9. Cytotoxic medicines- anagen effluvium
Smoking:
10. Tobacco smoking damages the lining of blood vessels- inducing hair loss

Differential Diagnosis

Alopecia Areata:

1. Autoimmune disease
2. Positive family history
3. Uncommon condition
4. Mainly affects children and adolescent
5. Patients will notice circular patches of hair loss on anywhere of the body
6. Will seek medical help when they notice hair loss on scalp or eyebrows
7. Condition self-limiting, may come back from time to time

Traction alopecia:

1. Mainly commonly seen in women

2. Hair loss due to sustained tension on the hair- usually as a result of styling hair with rollers
or a particular hairstyle

Trichotillomania:

1. Psychiatric disorder
2. Patient resists urge to pull their hair
3. Patient often deny this
4. Hair loss is asymmetrical and unusual shape
5. Must refer to a GP

Medicine induced alopecia:

1. If medicines other than cytotoxic are suspected- refer to the doctor or contact prescriber

Tine Capitis:

1. Well circumscribed round patch of alopecia

2. Itchy and scaly
3. Redness
4. Little black dots on the scalp due to infection
5. Refer for oral antifungal treatment from the doctors
Underlying endocrine disorder:

1. Diabetes mellitus, hypopituitarism, hypothyroidism can result in poor hair growth

Nutritional factors:

1. See a doctor or get a blood test to see if their lacking nutrients that is impacting hair growth

Radiation:

1. Radiation therapy could cause hair loss (damage to hair follicle on scalp)
2. If its once off hair should grow back, but ongoing refer to doctor

Questions to Ask:

1. Does your hair loss start from anterior region or vertex region? Only manage vertex region
2. Is the hair loss ongoing or acute? If it is acute or sudden onset its unlikely androgenic
alopecia could be something else.
3. Any other symptoms such as itchy, redness, black dots?
4. Do you have any chronic diseases, infection, autoimmune disease, liver or renal disease?
5. Do you have any triggers?
6. Any hair care procedures or using any hair style products?
7. How is your diet? Get a blood test if certain important vitamins are deficient
8. Any recent weight loss?
9. Do you have any family history of androgenic alopecia?
10. Are you on any medications?

REFFERAL POINTS!

1. Fungal infection of the scalp

2. Patients under the age of 18, and over the age of 65
3. Possible endocrine disorder
4. Sudden onset of hair loss
5. Suspected iron deficiency
6. Trichotillomania
7. Medicine-induced hair loss

Treatment for androgenic alopecia or Male/Female pattern baldness:

- Minoxidil is only for patients who have general thinning of hair on the top of the scalp
(vertex only)
- Not intended for frontal baldness or a receding hairline
- Available in strengths: 2% and 5%
- Men formulations the solution and foam is 5 percent, whereas the women formulation
for topical solution is 2% and the foam is 5 percent
- Successful treatment requires lifelong commitment, even if improvement is noticed,
need to use continuously
- Discontinuing the application causes regression to pre-treatment baldness within 6-12
months
- Foam less irritating than topical solution, and less likely to cause contact dermatitis, less
greasy and easier for the patient to apply.
- Results may occur at 4 months with BD usage
- Discontinue use if no improvement after 6 months of use
- Pregnancy category C- SO AVOID!
- Breastfeeding compatible (but the manufacturer recommends avoiding)
- Avoid in hypertensive patients
- Can cause skin irritation and headaches
- May change hair color and or/texture
Minoxidil not recommend if:

1. No family history of hair loss

2. Hair loss is sudden or unexplained hair loss
3. Under 18 years of age or over age of 65
4. Scalp is red, inflamed, infected, irritated or painful
5. Using other medicines on the scalp
6. Pregnant or breastfeeding
7. Diameter is bigger than 10cm

Adverse effects of Minoxidil include:

1. Itching and prickling

2. Headaches
3. Dizziness
4. Heartbeat irregularities
5. Changes in hair color and texture
6. Swollen hands or feet